Physician Advisor: Utilization & Revenue Strategy

Long Tail Health Solutions Inc.; Long Beach (CA); On-site; USD 150,000 - 230,000; Full time

Job summary

Long Tail Health Solutions Inc. in Long Beach, CA, seeks a Physician Advisor to support utilization management, case management, and revenue cycle operations within a health system.

The role involves medical necessity reviews, inpatient/outpatient status support, payer peer-to-peer reviews, complex case escalation, and physician engagement to ensure CMS and payer compliance. A Doctorate in Medicine or Osteopathy and 3 years of clinical practice are required, with board certification and active

Qualifications

• Doctorate from an accredited Medical or Osteopathic School.
• 3 years of experience in a clinical practice.
• Prior experience in physician advisory OR certification as a physician advisor.
• Board Certified in applicable specialty.
• Active medical staff privileges at health system obtained within ninety (90) days of hire.

Responsibilities

• medical necessity and patient status review;
• inpatient, outpatient, and observation status support;
• payer peer-to-peer reviews and appeals;
• complex case and discharge barrier escalation including MDRs;
• length-of-stay and readmission management support;
• physician engagement and education regarding utilization management, documentation, and applicable CMS and payer requirements.
• Other duties as assigned

Skills

Physician advisor

Education

Doctorate in Medicine or Osteopathic

Job description

Long Tail Health Solutions Inc. in Long Beach, CA, seeks a Physician Advisor to support utilization management, case management, and revenue cycle operations within a health system.

The role involves medical necessity reviews, inpatient/outpatient status support, payer peer-to-peer reviews, complex case escalation, and physician engagement to ensure CMS and payer compliance. A Doctorate in Medicine or Osteopathy and 3 years of clinical practice are required, with board certification and active